Öz
Introduction: Whilst fever is one of the key defence mechanisms of the body, it also causes raised intracranial pressure ICP by accelerating metabolic activity in neurosurgical patients and adversely affects the healing process. In the literature, fever control in neurosurgical patients is reported to be effective in preventing adverse consequences arising from uncontrolled fever.Material and Methods: This study employs a retrospective descriptive methodology. It was undertaken by examining a sample of medical records for 72 patients. All were over 18 years of age, had remained in the Neurosurgical Intensive Care Unit of a University Hospital for at least one week and had a recorded axillary temperature exceeding 38°C. Written permission from the Ethics Committee of the relevant institution was obtained to allow the research to proceed. Data were gathered between September 2013 and February 2014 using a data collection form developed by the researchers. Descriptive statistical methods frequency, average, standard deviation were used for the data analysis.Results: 72 out of 180 40% patients admitted to NICU between 2010 and 2014 developed a fever. The principal interventions by nurses to maintain fever control were identified as: giving an antipyretic agent by doctor’s order 98.6% , using a cooling electrical fan 88.9% , giving a tepid bed bath 75% and adjusting the room temperature or removing blankets 72.2% . The most frequently used antipyretic agents were identified as metamizole sodium 27.8% , a combination of metamizole sodium and paracetamol 26.4% or paracetamol alone 16.7% . Conclusion: From the study data, it was determined that the most frequent method used to provide fever control in NICU patients was pharmacological, and that the most frequently used nursing interventions were attempts at physical cooling
Anahtar Kelimeler
Fever neurosurgical intensive care unit nursing interventions physical cooling methods
Kaynakça
- Fetzer SJ. Vital signs. In: P.A. Potter, A.G. Perry (Ed.), Fundamentals of Nursing.7th ed. St.Louis: Mosby Elsevier, 2009: 502-51.
- American Association of Neuroscience Nurses (AANN) (2012). Nursing management of adults with severe traumatic brain injury. AANN Clinical Practice Guideline Series. Erişim adresi: http://www. aann.org/pubs/content/guidelines.html Erişim tarihi: 02.04.2019.
- Marion DW. Controlled normotermia in neurologic intensive care. Crit Care Med 2004; 32: 43-5.
- Rabinstein AA, Sandhu K. Non-infectious fever in the neurological intensive care unit: incidence, causes and predictors. J Neurol Neurosurg Psychiatry 2007; 78: 1278-80. [CrossRef]
- Li J, Jiang JY. Chinese Head Trauma Data Bank: Effect of hyperthermia on the outcome of acute head trauma patients. Journal of Neurotrauma 2012; 29: 96-100. [CrossRef]
- Bohman, LE, & Levine, JM. Fever and therapeutic normothermia in severe brain injury: an update. Current Opinion in Critical Care 2014;20: 182-8. [CrossRef]
- Commichau C, Scarmeas N, Mayer SA. Risk factors for fever in the neurologic intensive care unit. Neurology 2003; 60: 837-41.
- in the general intensive care unit. Am J Crit Care 2008;17:522-31.
- Meier K, Lee K. Neurogenic fever: review of pathophysiology, evaluation, and management. J Intensive Care Med 2017; 32: 124-9. [CrossRef]
- Cunha BA. Clinical approach to fever in the neurosurgical intensive care unit: Focus on drug fever. Surg Neurol Int 2013;4:318-22. [CrossRef]
- Asgar Pour H, Yavuz M. Effects of fever on haemodynamic parameters in neurosurgical intensive care unit patients. Intensive and Crit Care Nurs 2014; 30: 325-32. [CrossRef]
- Wang Z, Shen M, Qiao M, Zhang H, Tang Z. Clinical factors and incidence of prolonged fever in neurosurgical patients. J Clin Nurs 2016; 26: 411-7. [CrossRef]
- Stretti F, Gotti M, Pifferi S, Brandi G, Annoni F, & Stocchetti N. Body temperature affects cerebral hemodynamics in acutely brain injured patients: an observational transcranial color-coded duplex sonography study. Crit Care 2014; 18: 552. [CrossRef]
- Altun Uğraş G, Yüksel S. Factors affecting intracranial pressure and nursing interventions. Jacobs Journal of Nursing and Care 2014;1:1-4.
- Mathai K.I, Sudumbrekar S.M, Shashivadhanan M.S. Sengupta S.K, Rappai T.J. Decompressive craniectomy in traumatic brain injury rationale and practice. Indian J Neurotrauma 2010; 7: 9-12.
- Thompson HJ, Kirkness CJ, Mitchell PH. Fever management practices of neuroscience nurses, part II: nurse, patient, and barriers. J Neurosci Nurs. 2007a; 39: 196-1.
- Bratton SL, Chesnut RM., Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain. J Neurotrauma 2007; 24 (Suppl 1): 1-106.
- Thompson HJ, Kirkness CJ, Mitchell PH, Webb DJ. Fever management practices of neuroscience nurses: national and regional perspectives. J Neurosci Nurs. 2007b; 39: 151-62.
- Çelik S, Yıldırım İ, Arslan İ, Yıldırım S, Erdal F, Yandı YE. Hemodynamic and oxygenation changes in surgical intensive care unit patients with fever and fever lowering nursing interventions. Int J Nurs Pract 2011; 17: 556-61. [CrossRef]
- Hata JS, Shelsky CR, Hindman BJ, Smith TC, Simmons JS, Todd MM. A prospective, observational clinical trial of fever reduction to reduce systemic oxygen consumption in the setting of acute brain injury. Neurocrit Care, 2008; 9: 37-44. [CrossRef]
- Ikematsu Y. Characteristics of and interventions for fever in Japan. Int Nurs Rev, 2004; 51: 229-39. [CrossRef]
Öz
Giriş-Amaç: Bedenin önemli savunma mekanizmalarından biri olan ateş, nöroşirürji hastalarında metabolik aktiviteyi hızlandırarak, kafa içi basınç KİB artışına neden olmakta ve iyileşme sürecini olumsuz etkilemektedir. Literatürde, nöroşirürji hastalarında ateş kontrolünün, ateşe bağlı gelişebilecek sorunların önlenmesinde etkili olduğu bildirilmektedir.Gereç-Yöntem: Retrospektif tanımlayıcı tipteki bu araştırma, bir üniversite hastanesinin Nöroşirürji Yoğun Bakım Ünitesi’nde NYBÜ , en az bir hafta yatan ve aksillar beden sıcaklığı > 38°C olan, 18 yaş ve üzeri 72 hasta dosyası incelenerek gerçekleştirildi. Araştırmanın uygulanabilmesi için ilgili kurumdan ve yerel etik kuruldan yazılı izin alındı. Veriler, Eylül 2013-Şubat 2014 tarihleri arasında araştırmacılar tarafından geliştirilen veri toplama formuyla toplandı. Veri analizinde; tanımlayıcı istatistiksel yöntemler frekans, ortalama, standart sapma kullanıldı.Bulgular: NYBÜ’nde 2010- 2014 yılları arasında en az 1 hafta yatan 180 hastadan 72’sinde %40 ateş oluştuğu saptandı. Ateş kontrolünü sağlamak amacıyla hemşireler tarafından uygulanan başlıca girişimlerin, hekim istemi ile antipretik ilaç tedavisi uygulama %98,6 , fan/vantilatör kullanma %88,9 , ılık silme banyo verme %75 ve odanın sıcaklığını ayarlama/battaniyeleri uzaklaştırma %72,2 olduğu belirlendi. En sık kullanılan antipretik ilaçların, metamizol sodyum %27,8 , metamizol sodyumasetaminofen kombinasyonu %26,4 ve asetaminofen %16,7 olduğu saptandı. Sonuç: Araştırmadan elde edilen verilere göre, NYBÜ’nde yatan hastalarda ateş kontrolünü sağlamak amacıyla en yaygın kullanılan yöntemin farmakolojik tedavi olduğu, en sık uygulanan hemşirelik girişimlerinin de, fiziksel soğutmayı sağlayan yöntemler olduğu saptandı
Anahtar Kelimeler
Ateş nöroşirurji yoğun bakım ünitesi hemşirelik girişimleri fiziksel soğutma yöntemleri
Kaynakça
- Fetzer SJ. Vital signs. In: P.A. Potter, A.G. Perry (Ed.), Fundamentals of Nursing.7th ed. St.Louis: Mosby Elsevier, 2009: 502-51.
- American Association of Neuroscience Nurses (AANN) (2012). Nursing management of adults with severe traumatic brain injury. AANN Clinical Practice Guideline Series. Erişim adresi: http://www. aann.org/pubs/content/guidelines.html Erişim tarihi: 02.04.2019.
- Marion DW. Controlled normotermia in neurologic intensive care. Crit Care Med 2004; 32: 43-5.
- Rabinstein AA, Sandhu K. Non-infectious fever in the neurological intensive care unit: incidence, causes and predictors. J Neurol Neurosurg Psychiatry 2007; 78: 1278-80. [CrossRef]
- Li J, Jiang JY. Chinese Head Trauma Data Bank: Effect of hyperthermia on the outcome of acute head trauma patients. Journal of Neurotrauma 2012; 29: 96-100. [CrossRef]
- Bohman, LE, & Levine, JM. Fever and therapeutic normothermia in severe brain injury: an update. Current Opinion in Critical Care 2014;20: 182-8. [CrossRef]
- Commichau C, Scarmeas N, Mayer SA. Risk factors for fever in the neurologic intensive care unit. Neurology 2003; 60: 837-41.
- in the general intensive care unit. Am J Crit Care 2008;17:522-31.
- Meier K, Lee K. Neurogenic fever: review of pathophysiology, evaluation, and management. J Intensive Care Med 2017; 32: 124-9. [CrossRef]
- Cunha BA. Clinical approach to fever in the neurosurgical intensive care unit: Focus on drug fever. Surg Neurol Int 2013;4:318-22. [CrossRef]
- Asgar Pour H, Yavuz M. Effects of fever on haemodynamic parameters in neurosurgical intensive care unit patients. Intensive and Crit Care Nurs 2014; 30: 325-32. [CrossRef]
- Wang Z, Shen M, Qiao M, Zhang H, Tang Z. Clinical factors and incidence of prolonged fever in neurosurgical patients. J Clin Nurs 2016; 26: 411-7. [CrossRef]
- Stretti F, Gotti M, Pifferi S, Brandi G, Annoni F, & Stocchetti N. Body temperature affects cerebral hemodynamics in acutely brain injured patients: an observational transcranial color-coded duplex sonography study. Crit Care 2014; 18: 552. [CrossRef]
- Altun Uğraş G, Yüksel S. Factors affecting intracranial pressure and nursing interventions. Jacobs Journal of Nursing and Care 2014;1:1-4.
- Mathai K.I, Sudumbrekar S.M, Shashivadhanan M.S. Sengupta S.K, Rappai T.J. Decompressive craniectomy in traumatic brain injury rationale and practice. Indian J Neurotrauma 2010; 7: 9-12.
- Thompson HJ, Kirkness CJ, Mitchell PH. Fever management practices of neuroscience nurses, part II: nurse, patient, and barriers. J Neurosci Nurs. 2007a; 39: 196-1.
- Bratton SL, Chesnut RM., Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain. J Neurotrauma 2007; 24 (Suppl 1): 1-106.
- Thompson HJ, Kirkness CJ, Mitchell PH, Webb DJ. Fever management practices of neuroscience nurses: national and regional perspectives. J Neurosci Nurs. 2007b; 39: 151-62.
- Çelik S, Yıldırım İ, Arslan İ, Yıldırım S, Erdal F, Yandı YE. Hemodynamic and oxygenation changes in surgical intensive care unit patients with fever and fever lowering nursing interventions. Int J Nurs Pract 2011; 17: 556-61. [CrossRef]
- Hata JS, Shelsky CR, Hindman BJ, Smith TC, Simmons JS, Todd MM. A prospective, observational clinical trial of fever reduction to reduce systemic oxygen consumption in the setting of acute brain injury. Neurocrit Care, 2008; 9: 37-44. [CrossRef]
- Ikematsu Y. Characteristics of and interventions for fever in Japan. Int Nurs Rev, 2004; 51: 229-39. [CrossRef]
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2019Sayı: 2 |